Sinusitis

GENERAL INFORMATION:

What is sinusitis?

• Sinusitis is an inflammation (swelling) of the lining of your sinuses. Sinuses are hollow spaces inside the skull that are located behind the bones of your forehead, cheeks, and eyes. They are lined by mucous membranes that are clean and sterile (germ-free). Cilia (small hairs) in the mucus membranes help mucus drain into the nose through small openings called ostia.
  
  
• With sinusitis, the ostia may be blocked or the cilia may not be working properly. When this happens, mucus cannot drain properly from the sinuses. Germs grow in the mucus and cause an inflammation of the sinuses. Sinusitis may be acute, subacute, chronic, or recurrent. It is acute when the signs and symptoms last less than four weeks. Subacute sinusitis lasts from four to 12 weeks, while chronic sinusitis lasts longer than 12 weeks. Recurrent sinusitis happens when you have three or more episodes of acute sinusitis in one year. Sinusitis most commonly occurs during fall, winter, and spring. Diagnosing and treating sinusitis as soon as possible may relieve your symptoms and improve your quality of life.

What causes sinusitis? Sinusitis usually occurs when mucus cannot drain properly, such as during or just after a cold. Germs, such as bacteria and viruses, may grow in the mucus, causing a sinus infection. The following conditions may also increase your risk for developing sinusitis:

• Abnormal sinus structure: Any disease or condition that changes the structure of the sinuses may block the ostia, such as tumors. Nasal polyps (growths) and a septal deviation (crooked nose) may also prevent mucus from draining properly.
  
  
• Allergens: Irritants, such as smoke, dust, pollens, fungi (mold), and dust mites may cause swelling in the area near the ostia. This swelling may prevent mucus from draining properly. Chronic sinusitis may be caused by an allergen or asthma, which is an allergic disease.
  
  
• Barotrauma: Sudden changes in air pressure and temperature may cause an increased production of mucus, such as during swimming.
  
  
• Breathing support: The use of ventilators, nasal tubes, or nasal catheters for breathing support may cause sinusitis.
  
  
• Dental: Problems with the gums and teeth, such as a gum infection and tooth decay (cavities), may spread to the sinuses. Surgeries, such as a tooth removal, root canal, or a tooth implant, may also cause sinusitis.
  
  
• Immune: Diseases that decrease the ability of your body to fight an infection, such as diabetes, may cause a recurrent sinusitis. The immune system is your body's defense system against infections and diseases.
  
  
• Others: Infections of the ear or upper respiratory tract (body parts involved in breathing), such as rhinitis, may spread to the sinuses. Cystic fibrosis, a genetic disease that causes mucus to become thick may also cause chronic sinusitis. Thick mucus makes it hard for cilia to move mucus out of the sinuses.

What are the signs and symptoms of sinusitis? You may have any of the following:

• Dry cough that happens mostly at night and when lying down. You may also have a sore throat.
  
  
• Fever, tiredness, chills, and body pains.
  
  
• Headache and face pain that is worse when leaning forward.
  
  
• Post nasal discharge, which may be thick and yellow or green-colored.
  
  
• Pain in your teeth or pain when chewing.
  
  
• Pain, pressure, or swelling around the forehead, cheeks, or eyes.
  
  
• Trouble smelling.

How is sinusitis diagnosed? Sinusitis is diagnosed based on symptoms present and how long you have had them. Sinusitis is usually considered when symptoms have not improved after seven days. Your caregiver will take a detailed health history from you. This includes any nose problems or injuries you may have had. He may also check for problems with your gums and teeth. He may need to know if you have allergies and how often you have had a sinus problem. Your caregiver will check inside your nose using a nasal speculum. A nasal speculum is an instrument used to open the nostrils to better see the inside of the nose. You may also have any of the following tests:

• Culture: This is a test that may help caregivers learn which type of germ is causing your sinus infection. A sample of the cells from the mucus discharge of your nose may be sent to a lab for tests.
  
  
• Endoscopy: This test uses a scope to see the inside of your sinuses. A scope is usually made of a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may look into your nose where the sinuses drain. Caregivers will look for polyps, tumors, and any other condition that may be causing your sinusitis. Samples may be taken from the inside of your sinuses and sent to a lab for tests.
  
  
• Imaging tests:
  
  
  • Computerized tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your sinuses. Dye may be given before the pictures are taken. The dye may help sinus disease, a structure problem, or other problems, such as polyps, show up better in the pictures. Tell your caregiver if you are allergic to shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye.
    
    
  • Magnetic resonance imaging scan: This test is called an MRI scan. During the MRI, pictures are taken of your sinuses. An MRI may also be taken of your nose, face, and skull. You will need to lie still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
    
    
  • Ultrasound: This is a test that uses sound waves to look inside your nose and sinus area. Pictures are shown on a TV-like screen. Your caregiver may do an ultrasound to better see your sinuses and look for an infection.
    
    
  • X-rays: You may need to have x-rays of your nose, face, and sinuses taken. This will help your caregiver know if you have problems in any of these areas. You may need more than one x-ray.
  
  
• Sinus puncture: A needle may be inserted into your sinuses to get fluid and tissue samples. This may show what kind of germ is infecting your sinuses. The fluid and tissue samples will be sent to a lab for tests.
  
  
• Other tests: You may have blood or other tests, such as a sweat test, if you have chronic sinusitis. These tests may be used to check for an immune system problem or a genetic problem, such as cystic fibrosis.

How is sinusitis treated? You may have any of the following:

• Functional endoscopic sinus surgery: This surgery uses an endoscope, which is a long, bendable tube with a light and video camera at the end. Functional endoscopic sinus surgery may be done if your sinusitis does not respond to medicine. Fungal, polyps, tumors, or damaged tissue from the sinus may be removed to improve mucus drainage.
  
  
• Gum and tooth problems: Problems with your gums and teeth may be treated by another caregiver, called a dentist.
  
  
• Medicine: You may need antibiotic medicine to fight a sinus infection caused by germs, such as bacteria or fungi. You must take this medicine as advised by your caregiver even after you start to feel better. Your caregiver may also give you medicine to relieve your symptoms, such as medicine for fever, pain, and a cough. Steroid medicine may be given to you if you have chronic sinusitis or your sinusitis is caused by an allergen. Decongestant medicines may be used, but not for longer than three days.
  
  
• Steam inhalation: Inhaling steam from a vaporizer or a warm cup of water may help you breathe easier and loosen dry mucus.

Where can I find more information? Having sinusitis may be hard for you and affect your quality of life. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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